Hate to throw stuff away? Hang onto broken dishware, thinking you’ll take up mosaics? Do you tuck away your grandma’s china, too nice to use – but never take it out? If these habits sound familiar, you may be a pack rat. Although many of us pile up clutter, for some people hoarding may be a sign of an obsessive-compulsive disorder…

Aesop’s fable of the industrious ant laying away supplies for the winter is no fairy tale. In the animal kingdom, hoarding is a way to survive times when food is scarce. But only in humans does this instinctive tendency go pathologically awry.

Compulsive hoarders (the term preferred by physicians over pack rat) can fill houses with so much junk that whole rooms are consumed and rendered unusable. Hoarders can also become dysfunctional, isolating themselves and losing documents like driver’s licenses, bills and medical records that help people run their lives. And in some cases, their crammed homes become fire or health hazards.

The most famous compulsive hoarder was Langley Collyer, who for 15 years filled a New York City mansion with 120 tons of trash, including 11 pianos and all the parts of a Model T Ford. He and his reclusive brother were both found dead among the clutter, having died just days apart. Langley had been crushed by falling debris.

Compulsive hoarding affects more than one million people in the United States – and that is likely an underestimate given that hoarders tend to seclude themselves, uncounted. Studies suggest that hoarding also tends to run in families, suggesting a possible genetic link. In fact, compulsive hoarders share common traits – for example, an inability to make decisions. Their indecisiveness may in turn aggravate the compulsion to collect, getting in the way of commonsense decisions to discard unneeded items. Hoarders may also bounce from one project or activity to another in a way that resembles people with attention deficit hyperactivity disorder (ADHD). Many lack motivation and find it hard to initiate complex tasks or hold employment. Hoarders may also be chatterboxes, talking incessantly and in excruciating detail.

The Link to Other DisordersIn fact, hoarding behaviors are associated with a number of psychiatric disorders, including ADHD, age-related dementia, certain cognitive impairments, and, most commonly, obsessive-compulsive disorder (OCD). Up to one-third of OCD patients suffer from compulsive hoarding, and some experts believe that hoarding may well be a subset of this disorder. OCD is characterized by recurrent behaviors or compulsions significant enough to interfere with a person’s normal routines. The obsessions are persistent thoughts that feel inappropriate and intrusive and often accompany anxiety or distress. The compulsions, which the person seems to have little control over, are rituals intended to reduce that distress.

Those with OCD are typically obsessed about being soiled or contaminated, forgetting to do something or being embarrassed. They may also have fears about hurting someone or something. Common compulsions include putting things in a set order, excessive washing, cleaning or folding, repeated checking on items or processes, and hoarding or saving items.

OCD is fairly common. Approximately 2.5% of the U.S. population – 7.5 million people – suffer from the disorder. Many with OCD fail to seek treatment and lead lives of relative isolation. They try to adapt to the ebb and flow of their disorder, which tends to worsen during periods of stress. But the obsessive thoughts and coping patterns become ingrained, and those afflicted may lead a largely dysfunctional life.

Most of us have experienced thoughts similar to those of people with OCD. We might ruminate on an event or conversation or can’t get a particular concern out of our heads. The difference is the lesser degree of stress we suffer from such thoughts and how we cope with them. Those without OCD might talk to a friend, go for a walk, turn on music, or tend to the garden as a coping mechanism. But those with OCD attempt to relieve their fear and anxiety in a highly repetitive and ritualized manner. There may be temporary relief, but the fear and anxiety flood back.

Despite the overlap of OCD and hoarding, some experts believe the disorders may be distinct, in part because many compulsive hoarders appear to take pleasure in their behavior, much like gamblers or compulsive shoppers do – finding comfort or even delight in their accumulated clutter. This isn’t just trash to them but valued objects or gems yet to be discovered. Those who suffer from OCD, however, get no joy from their actions, but simply momentary relief from stress.

The Brain ConnectionResearch at the University of California-Los Angeles (UCLA) suggests that compulsive hoarding may correspond with abnormal activity in certain parts of the brain. When brain scans of people with OCD were compared to hoarders, each had distinct patterns. Compared to OCD patients, hoarders had more suppressed brain activity in parts of the brain involved in visual-spatial orientation and in other areas associated with tension, motivation and decision-making. And the more severe the hoarding symptoms, the more suppressed the brain activity.

Another study at the University of Iowa appears to corroborate the UCLA findings. Thirteen victims of non-fatal strokes and other neurological diseases suddenly began to exhibit hoarding behavior. The victims began a “massive and disruptive accumulation of useless objects,” according to the study. And the area of the brain affected in the Iowastudy group correlated closely with the regions identified in the UCLA study.

The findings may lead to new treatments. Traditional therapy for OCD, including selective serotonin reuptake inhibitors (SSRIs), is typically less effective for compulsive hoarders, possibly because hoarders may be a distinct class of OCD whose brains are “wired” differently. Consequently, researchers are now looking at other options for compulsive hoarders such as cognitive-enhancing medications used for dementia patients or stimulant drugs like Ritalin that improve attention and concentration.

Another treatment option is cognitive-behavioral therapy, a non-pharmacological treatment focused on addressing the thought process behind the disorder. Getting a hoarder to throw stuff away doesn’t remedy the problem. He or she will soon get busy gathering replacements. Addressing that person’s decision-making – the moment when he or she decides to save something – is more likely to be helpful.

If you lean toward hoarding, here are some tips that may help you cope:

Discard broken items or those you have not touched in two years.

Empty and then eliminate temporary storage areas.

Throw out duplicate items if you really only need one.

Periodically engage the family in clean-up days to eliminate clutter from living and storage areas.

Don’t buy more of an item than you might need to use over the next 3 to 6 months.

Consider contacting a therapist trained in this disorder. Contact the Obsessive-Compulsive Foundation, (ocfoundation.org) for help in finding a therapist experienced in addressing OCD or compulsive hoarding.

Are You A Pack Rat?Collecting things can be a harmless habit, but compulsive hoarding is a serious disorder. Take this pack rat quiz to find out if you're more than a casual collector and may need help with your hoarding habits.

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